INTRODUCTION

In most countries, including Brazil, the use of psychoactive substances is a very common characteristic, with many cultural, biological, psychological and social variables that simultaneously influence their consumption, such as¹. Among so many substances, alcoholic beverages stand out for always being present in most social occasions, where 80% of people consume them, and of these, 10% are alcoholics (a term currently used to replace “alcoholic” – alcohol lover, as it is less stigmatizing and more appropriate to address this dependent public) ² .

Many users begin consuming alcohol in low doses, mainly because of its euphoric action and its ability to reduce inhibitions, which facilitates social interaction. Doses that tend to increase, due to the need for progressively larger quantities of the substance (tolerance) and, in more severe cases, withdrawal syndrome ³ . There are, therefore, a variety of patterns of frequency and intensity of alcohol use, namely: experimental, occasional, regular, abusive, harmful and dependent use ⁴ . It is worth noting, however, that the World Health Organization (WHO) establishes that there is no consumption of psychoactive substances without harm to the person who consumes it ⁵ .

In order to better reflect on the problem of alcoholism in the population, the economic and social costs arising from alcoholism worldwide are highlighted. Alcohol use is associated with 25 to 50% of traffic accidents with fatal victims, in addition to being associated with unemployment, crime, health problems and premature deaths ⁶ . Therefore, it is also necessary to look at research and interventions in education, prevention and health promotion with young people, especially adolescents.

Alcohol consumption in adolescence and the importance of appropriate approaches

A potentially at-risk group is young people. It is understood that pre-adolescence and adolescence are phases of experimentation with various behaviors, based on stimulation and provision of opportunities. A fundamental process for the construction of one’s own identity, image and social role. Thus, the adolescent comes into contact with new activities that need to be accepted in the social group, such as starting to use psychoactive substances, in most cases, drinking alcohol ⁷ .

It is recognized that, especially among young people, patients’ adherence to a treatment program or the recognition of prevention tools are conditioned by their motivation and understanding of what they consume, its effects and risks to their health ⁸. Motivation and educational work can be performed through Motivational Interviewing and Psychoeducation, which can be disseminated through tools that are easy to adopt among young people and adolescents, such as mobile applications.

Motivational Interviewing has a series of techniques and principles that can increase the patient’s motivation and adherence to treatment, contributing to the establishment of a bond between the patient, the therapist and the other participants. The methodology also helps the patient feel comfortable talking about alcohol and realize that they will be understood without being confronted ^9-10 . Thus, reinforcing the “readiness for change”, the patient goes through different stages organized by Prochaska and DiClemente: pre-contemplation, contemplation, preparation, action and maintenance ¹¹ . Psychoeducation, on the other hand, is reinforced by the importance of teaching the user and their family members about the problems related to substance use, its treatment and associated difficulties – a sine qua non

condition for the treatment process. It also reinforces the importance of learning methods to monitor certain types of behavior, their severity and their symptoms. Psychoeducational interventions facilitate acceptance and cooperation in coping with difficulties ¹² . These interventions can be more accessible, with greater dissemination and adherence, when combined with mobile communication devices ( smartphones , tablets ), through the creation of a smartphone application . Mobile computing, understood as mobile health , according to the WHO, is the medical practice that supports mobile devices, such as smartphones , patient monitoring devices and other wireless devices. To meet this practice, this type of technology proposes to improve and extend the quality of programs to increase the reach of services and strengthen health information systems. Its use also has advantages in terms of saving time, better data exchange, reducing the loss of information that is stored on the device and collecting information from patients in their environments without the need for travel ¹³ . In view of the above, the present study aims to present a mobile application developed with the objective of collaborating with the self-perception of alcohol users regarding their level of alcohol consumption. RESEARCH METHOD

This study involves the development of a mobile application through comparative analysis of registered consumption data that serves as a tool for identifying the level of consumption among alcohol users and raising self-awareness of the risks associated with their respective levels of consumption, accessing psychoeducational information about alcohol, and analyzing economic costs.

The idea arose from the observation of two growing poles in society. On the one hand, the spread of alcohol use, especially among young people. On the other hand, the expansion of the daily use of technologies, such as the use of mobile communication devices ( smartphones , tablets, etc.), the popularization of Internet utilities , and the growth of accessibility to all social classes. It is understood that, through these new technologies, complementary alternatives and differentiated approaches can be created to reach this young audience of alcohol users, which can arouse interest through the proposal of granting the user the power to self-evaluate in a playful and interactive way.

Through the analysis of the proposed methodology, requirements were identified for the creation of a mobile application, built through the alliance of multidisciplinary efforts of Psychology, Computer Science and Engineering, Social Work, Audiovisual and New Media within the scope of the Information Technology Application Center (NATI).

The research procedures begin with a bibliographic study and interviews conducted by the Psychology and Social Work team with a sample of participants directly involved (multidisciplinary team) and indirectly involved (patients from specialized clinics or public units) in the context of the problem. After this survey, the requirements for the application were identified:

A tool for tracking alcohol consumption patterns;

A tool for contemplation (working on ambivalences) regarding alcohol consumption;

A tool for recording and providing feedback on alcohol consumption and related financial expenditure;

A tool with educational information about alcohol.

With this, the application was created for the Android platform . Its functionalities are based on the Initial Analysis with an alcohol use identification scale, alcohol consumption record, Decisional Scale, Psychoeducation and quiz .

Once the functional needs of the application were established, we sought to identify a specific profile of the target audience, to which the application design will be directed with the aim of encouraging user adherence to the tool proposed here. As the bibliographic survey indicated that studies indicate a higher prevalence of alcohol consumption from the age of 14 ¹⁶ , the target audience was established as being between 15 and 25 years old, of both sexes, literate, who have an active social life, use smartphones and have not been diagnosed with alcohol dependence, considering that it is a tool for reflection on possible abusive behaviors.

After the need identification stage, the establishment of requirements and the target audience survey, team discussions began on the focus on the usability of the application, that is, what the nomenclature of its functionalities would be and how the information could be presented to the public with the aforementioned profile.

RESULTS

Based on the preliminary meetings and weekly discussions, the application was created and the testing phase began. Its interface and interaction design were planned based on persuasive design so that they are interactive and attractive to young people and adults. Thus, the developed mobile application has five main functionalities: 1) “Drinkometer” that meets the need for a brief screening to identify alcohol use using the AUDIT scale; 2) “Drink Counter” that aims to record the drinks consumed, the quantity of each and the record of financial expenses; 3) “I drink because…” aims to reassess drinking behavior by surveying the pros and cons of consumption; 4) “About alcohol” which will provide psychoeducational information, and; 5) “Quiz” which also aims to provide psychoeducational information although in an interactive way with questions and answers (see Figure 1).

Figure 1. Sketch of images of some of the application’s features.

“Drinkometer” Features

The “Drinkometer” is the first and crucial feature of the application, as it contains the scale that can classify what type of user he identifies as, when responding to a measuring instrument, the AUDIT, where the following commands will appear:

1. Answer the questionnaire: When accessing the “Drinkometer” feature, the user will be presented with one question at a time from the AUDIT scale, where they will answer the questions through a selection of pre-determined answers, which in total are counted in ten questions¹.

2. Suggestion of use classification: The application will classify the teenager according to the type of alcohol user they fit into, that is, according to the score achieved, the application will say that there is a suggestion between occasional, regular, abusive or dependent use.

3. Learn more: The application will provide data and information about what the user’s specific classification means.

“Drink Counter” Functionality

The Drink Counter provides the user with a record of the drinks that have been consumed, adapted according to the standard dose of the type of drink consumed, the record of the quantity consumed, the amount of money spent and the date it occurred.

1. Drinks log: when accessing the “Drinks Counter” feature, the application will provide images with names and the standard dose of each drink, based on milliliters (ml) and the alcohol concentration in percentage of the drink.

2. Quantity consumed: after choosing what was consumed, the user will record the quantity of each one or the only one they chose.

3. Total spent: in this, the user will record how much they spent on what was consumed.

4. Comparison: at the end of the month, the application will compare the amount of money they spent on alcohol consumption with how much they earn per month, considering that the user has entered their data regarding their income at the beginning of the registration.

“I Drink Because…” Features “

I Drink Because…” is a feature based on the Decisional Scale, a tool used in Motivational Interviewing that aims to explore ambivalent feelings regarding behaviors by exploring their pros and cons.

1. Choosing the advantages and disadvantages of drinking: first, the user will be asked to choose a series of advantages and then disadvantages of drinking alcohol that are in the application’s database.

2. Choosing the advantages and disadvantages of NOT drinking: this second step works in the same way, although the choices of advantages and disadvantages are made about not drinking alcohol.

3. Scale example: when the list of advantages and disadvantages is finished, the application will show an image of a scale indicating which side has more weight, whether it is the advantage or disadvantage of drinking, and in another image the weight of the advantage and disadvantage of not drinking.

This functionality can be understood as an important motivational intervention for resolving ambivalence with the structured visualization of advantages and disadvantages, contrasting with arguments related to exposure and protective factors of consumption. It is also important to update the decision-making balance at different moments of the treatment, collaborating with evidence for the cognitive restructuring of the patient ¹¹ .

Functionalities of “About Alcohol”

1. In “About Alcohol” psychoeducational information is presented that provides support for understanding the complexity and personal, social, economic and public health impacts that alcohol can cause. Information: in this feature, you will come into contact with various information that can support awareness of alcohol use, or gain knowledge to pass on to friends. This information consists of topics related to diagnosis, history of alcohol, laws on consumption, socioeconomic impacts, mental health, etc.

According to Wright, Basco and Thase ¹⁴ , Cognitive Behavioral Therapy (CBT) is based on the idea that patients can learn skills to modify cognitions, so psychoeducation is effective during the therapy process to equip patients with the knowledge that will help them reduce the risk of relapse.

“Quiz” Functionality

This functionality has the same objective as the previous one, “About Alcohol”, as it contains psychoeducational information to develop awareness and knowledge about alcohol. However, its approach is different, as it presents the information as a game of questions and answers, linked to curiosities or myths about alcohol, bringing a playful tone to the application.

1. Truth or myth: Here the application will give information and the user will answer whether it is true or myth.

2. Curiosities: In this one, the application will give information that is generally linked to popular beliefs and will give the user options to respond, later giving the correct answer about the information.

FINAL CONSIDERATIONS

Given the low number of prevention measures, the importance of a mobile application with self-use resources is considered, facilitating self-identification and giving users more responsibility for their actions, by providing sufficient support to perceive their current consumption and possible associated risks, without being critical or confrontational. Thus, users can benefit from the early observation of their behavior, which is commonly not perceived by young people in our society that has social values ​​about alcohol.

Thus, it is considered that the more prevention measures there are, the more effective it will be in raising awareness and reeducating people about alcohol use, understanding that the etiology of chemical dependency itself is quite varied. As a limitation of the tool, we identify the absence of a health professional who could use the application’s functionalities as an intervention and establishing a therapeutic bond, since the application will not replace the treatment, suggestions or interventions made by professionals who work in this area.

The path taken to develop this tool provides ideas for extending its usefulness, serving as a great incentive for research at a national level, both for understanding the use of alcohol by users of this tool, seeking the association of socioeconomic variables with alcohol abuse or dependence. This can also imbue feelings about alcohol consumption, as well as not doing so, understanding the willingness to invest in the amount of money for alcohol use and promoting awareness of the possible health risks that abusive consumption can entail among adolescents and young adults in Brazilian society.